Zabarsky Gali, Beek Cherise, Hagman Emilia, Pierpont Bridget, Caprio Sonia, Weiss Ram
Department of Human Metabolism and Nutrition, Braun School of Public Health, Hebrew University, Jerusalem, Israel.
Department of Pediatrics, Yale University, New Haven, CT.
J Pediatr. 2018 Jan;192:105-114. doi: 10.1016/j.jpeds.2017.09.066.
To compare cardiovascular risk factor clustering (CVRFC) in severely obese youth with those with lower degrees of obesity.
We divided a childhood obesity clinic derived cohort into the degrees of obesity (class I, II, and III) and added a "class IV" category corresponding to >160% of the 95th centile of body mass index (BMI) for age and sex. In a cross-sectional analysis, we investigated the presence of CVRFC in 2244 participants; in 621 who were followed longitudinally, we investigated the determinants of endpoint CVRFC.
Class IV obesity was associated with increased risk for CVRFC compared with overweight (OR = 17.26, P < .001) at a similar magnitude to class III obesity (OR = 17.26, P < .001). Male children were at greater risk for presence of CVRFC (OR = 1.57, P = .03) compared with female children. Adiponectin (OR = 0.90, P < .001) and leptin levels (OR = 0.98, P = .008) were protective, independent of degree of obesity. Baseline class IV obesity was associated with increased risk compared with overweight of having CVRFC at follow-up (OR = 5.76, P = .001), to a similar extent as class III obesity (OR = 5.36, P = .001). Changes in the degree of obesity were significant predictors of CVRFC on follow-up (OR = 1.04, P < .01 per percent BMI change).
The metabolic risk associated with obesity in childhood is conferred prior to reaching class IV obesity. An individualized risk stratification approach in children with severe obesity should be based on presence of complications rather than simple BMI cutoffs.
ClinicalTrials.gov NCT01967849.
比较重度肥胖青少年与肥胖程度较低青少年的心血管危险因素聚集情况（CVRFC）。
我们将来自儿童肥胖门诊的队列按照肥胖程度分为I、II和III类，并增加了一个“IV类”，对应年龄和性别的体重指数（BMI）第95百分位数的>160%。在横断面分析中，我们调查了2244名参与者中CVRFC的存在情况；在621名接受纵向随访的参与者中，我们调查了终点CVRFC的决定因素。
与超重相比，IV类肥胖与CVRFC风险增加相关（OR = 17.26，P <.001），与III类肥胖的风险增加幅度相似（OR = 17.26，P <.001）。与女童相比，男童出现CVRFC的风险更高（OR = 1.57，P =.03）。脂联素（OR = 0.90，P <.001）和瘦素水平（OR = 0.98，P =.008）具有保护作用，且独立于肥胖程度。与超重相比，基线IV类肥胖与随访时出现CVRFC的风险增加相关（OR = 5.76，P =.001），与III类肥胖的程度相似（OR = 5.36，P =.001）。肥胖程度的变化是随访时CVRFC的重要预测因素（每BMI变化1%，OR = 1.04，P <.01）。
儿童肥胖相关的代谢风险在达到IV类肥胖之前就已存在。重度肥胖儿童的个体化风险分层方法应基于并发症的存在情况，而非简单的BMI临界值。
ClinicalTrials.gov NCT01967849
